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Systemic antibiotics fail to clear multidrug-resistant Klebsiella from a pediatric ICU
A J Petros1, M O'Connell, C Roberts
1Pediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
This study found that broad-spectrum antibiotics were ineffective against multidrug-resistant bacteria in a pediatric ICU. Surveillance cultures are crucial for distinguishing imported versus acquired resistance, as most resistant isolates were imported.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Pediatric intensive care units (PICUs) face challenges with infection rates and antimicrobial resistance.
- Understanding the epidemiology of multidrug-resistant organisms (MDROs) is critical for effective patient management.
Purpose of the Study:
- To determine the infection rate and antimicrobial resistance patterns in a pediatric ICU.
- To evaluate the efficacy of broad-spectrum antibiotics in controlling MDROs.
Main Methods:
- A 3-month prospective observational cohort audit was conducted in a 12-bed tertiary pediatric ICU.
- Surveillance cultures of throat and rectum were performed on children admitted for over 72 hours.
- Data on patient demographics, length of stay, ventilation days, and infection development were collected.
Main Results:
- Of 52 enrolled patients, 15 developed 21 infections; 7 carried MDROs, with 3 developing infections from these resistant bacteria.
- Gentamicin-resistant Klebsiella was the most common MDRO identified.
- Despite broad-spectrum antibiotic use, three children acquired multidrug-resistant Klebsiella within the PICU.
Conclusions:
- Surveillance cultures are essential to differentiate between imported and hospital-acquired MDROs.
- Two-thirds of resistant isolates in this study were imported into the PICU.
- Current broad-spectrum antibiotic strategies showed limited impact in controlling endemic multidrug-resistant Klebsiella.
Study Objectives:
To determine the magnitude of infection rate and antimicrobial resistance in a pediatric ICU (PICU), and to evaluate the efficacy of using broad-spectrum antibiotics.
Design:
A 3-month, prospective, observational cohort audit.
Setting:
A 12-bed tertiary, referral PICU.
Patients Or Participants:
All children admitted to the PICU for > 72 h.
Interventions:
Surveillance cultures of throat and rectum on admission and once weekly thereafter.
Measurements And Results:
Of the 150 admissions during the 3-month period, a total of 52 patients (24 girls and 28 boys) requiring mechanical ventilation for a minimum of 3 days were enrolled in the audit. The median age and interquartile range (IQR) was 17 months (IQR, 5.8 to 63); length of stay, 6.5 days (IQR, 4 to 13); ventilation days, 5 (IQR, 3 to 11); pediatric risk of mortality score, 14 (IQR, 9 to 19); and risk of mortality, 0.03 (IQR, 0.014 to 0.087). Fifteen patients (29%) developed 21 infections, mainly lower-airway infections and septicemias. Of the 52 children, 7 children carried multidrug-resistant bacteria and 3 patients progressed to develop four infections with those resistant bacteria. Of the seven carriers, six patients carried gentamicin-resistant Klebsiella. Methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae and gentamicin-resistant Pseudomonas aeruginosa each were carried by one child. Six of those nine resistant isolates were present in the admission flora. Despite the potent combination of piperacillin/tazobactam and amikacin, three children acquired the multidrug-resistant Klebsiella while in the PICU and became nosocomial carriers.
Conclusions:
Only surveillance cultures allow the distinction between import of multidrug-resistance and resistant bacteria acquired while in PICU. In this study, two thirds of the resistant isolates were imported. The introduction of newer potent systemic antibiotic combinations failed to control the endemic reservoir of multidrug-resistant Klebsiella and suggests that such policies have little impact.